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To investigate if walking is independently associated with low back pain (LBP) in the general population.
This cross-sectional study used public data from the Fourth and Fifth Korean National Health and Nutrition Examination Survey. Subjects included 5,982 community-dwelling adults aged ≥50 years. Presence of current LBP was defined as LBP for 1 month or more in the past 3 months. Walking was measured as total walking duration for the past week and subjects were divided into four quartiles. Independent effect of walking on LBP was determined using odds ratios (OR) adjusted for age, sex, osteoporosis, depression or anxiety, and radiographic lumbar spondylosis.
Prevalence of LBP was 26.4% in this population. Older people and women had higher prevalence of current LBP. Prevalence of obesity and osteoporosis was higher in subjects with current LBP and quality of life was poorer in subjects with current LBP. Adjusted logistic regression model revealed that older age (OR, 1.655; p=0.018), female sex (OR, 2.578; p<0.001), radiographic lumbar spondylosis (OR, 2.728; p<0.001), depression or anxiety (OR, 5.409; p<0.001), and presence of osteoporosis (OR, 1.467; p=0.002) were positively associated with current LBP. Walking decreased prevalence of current LBP proportionally (2nd quartile OR, 0.795; 3rd quartile OR, 0.770; and 4th quartile OR, 0.686 compared with the 1st quartile of walking).
Walking was negatively associated with LBP. Further studies are needed to reveal causal relationship of this phenomenon.
Citations
To investigate the feasibility of a knee proprioception evaluation using a dynamometer as a tool for evaluating proprioception of the lower extremities in patients with incomplete spinal cord injury (SCI), and to explore its usefulness in predicting the ambulatory outcome.
A total of 14 SCI patients (10 tetraplegic, 4 paraplegic; all AIS D) were included in this study. The passive repositioning error (PRE) and active repositioning error (ARE) were measured with a dynamometer, along with tibial somatosensory evoked potential (SSEP) and abductor hallucis motor-evoked potential (MEP). Ambulatory capacity was assessed with the Walking Index for Spinal Cord Injury II (WISCI-II), both at the time of the proprioception test (WISCI_i) and at least 6 months after the test (WISCI_6mo).
The PRE showed a negative correlation with WISCI_i (r=-0.440, p=0.034) and WISCI_6mo (r=-0.568, p=0.010). Linear multiple regression showed the type of injury, lower extremities motor score, MEP, and PRE accounted for 75.4% of the WISCI_6mo variance (p=0.080).
Proprioception of the knee can be measured quantitatively with a dynamometer in patients with incomplete SCI, and PRE was related to the outcome of the ambulatory capacity. Along with the neurological and electrophysiological examinations, a proprioception test using a dynamometer may have supplementary value in predicting the ambulatory capacity in patients with incomplete SCI.
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To predict ambulatory capacity, 1 month after physical therapy following hip fracture surgery.
A retrospective chart review was carried out. Patients more than 60 years old, who underwent hip fracture surgery and received physical therapies, were selected (n=548). Age, gender, presence of cognitive dysfunction, combined medical diseases, combined fractures, previous history of hip surgery, prefracture ambulatory capacity, days from the fracture to surgery, type of fracture, type of surgery, presence of postoperative complications, days from the surgery to physical therapy, and total admission period, were collected. Prefracture ambulatory capacity and postoperative ambulatory capacity were classified into non-ambulatory status (NA), ambulation with assistive device (AA), and independent-ambulation without any assistive device (IA). Multiple-logistic regression analysis was performed for the prediction of postoperative ambulatory capacity.
Age (odds ratio [OR]=0.94 for IA and 0.96 for IA or AA), gender (OR=1.64 for IA and 0.98 for IA or AA), prefracture ambulatory capacity (OR of IA=19.17 for IA; OR of IA=16.72 for IA or AA; OR of AA=1.26 for IA, OR of AA=9.46 for IA or AA), and combined medical disease (OR=2.02) were found to be the factors related to postoperative ambulatory capacity and the prediction model was set up using these four factors.
Using this model, we can predict the ambulatory capacity following hip fracture surgery. Further prospective studies should be constructed to improve postoperative ambulatory capacity.
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To investigate the effect of treadmill walking exercise as a treatment method to improve gait efficiency in adults with cerebral palsy (CP) and to determine gait efficiency during overground walking after the treadmill walking exercise.
Fourteen adults with CP were recruited in the experimental group of treadmill walking exercise. A control group of 7 adults with CP who attended conventional physical therapy were also recruited. The treadmill walking exercise protocol consisted of 3-5 training sessions per week for 1-2 months (total 20 sessions). Gait distance, velocity, VO2, VCO2, O2 rate (mL/kg·min), and O2 cost (mL/kg·m) were assessed at the beginning and at the end of the treadmill walking exercise. The parameters were measured by KB1-C oximeter.
After the treadmill walking exercise, gait distance during overground walking up to 6 minutes significantly increased from 151.29±91.79 to 193.93±79.01 m, and gait velocity increased from 28.09±14.29 to 33.49±12.69 m/min (p<0.05). Energy efficiency evaluated by O2 cost during overground walking significantly improved from 0.56±0.36 to 0.41±0.18 mL/kg·m (p<0.05), whereas O2 rate did not improve significantly after the treadmill walking exercise. On the other hand, gait velocity and O2 cost during overground walking were not significantly changed in the control group.
Treadmill walking exercise improved the gait efficiency by decreased energy expenditure during overground walking in adults with CP. Therefore, treadmill walking exercise can be an important method for gait training in adults with CP who have higher energy expenditure.
Citations
To determine the effect of robotic-assisted gait training (RAGT) compared to conventional overground training.
Sixty patients with motor incomplete spinal cord injury (SCI) were included in a prospective, randomized clinical trial by comparing RAGT to conventional overground training. The RAGT group received RAGT three sessions per week at duration of 40 minutes with regular physiotherapy in 4 weeks. The conventional group underwent regular physiotherapy twice a day, 5 times a week. Main outcomes were lower extremity motor score of American Spinal Injury Association impairment scale (LEMS), ambulatory motor index (AMI), Spinal Cord Independence Measure III mobility section (SCIM3-M), and walking index for spinal cord injury version II (WISCI-II) scale.
At the end of rehabilitation, both groups showed significant improvement in LEMS, AMI, SCIM3-M, and WISCI-II. Based on WISCI-II, statistically significant improvement was observed in the RAGT group. For the remaining variables, no difference was found.
RAGT combined with conventional physiotherapy could yield more improvement in ambulatory function than conventional therapy alone. RAGT should be considered as one additional tool to provide neuromuscular reeducation in patient with incomplete SCI.
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To quantify the activation of the paraspinalis muscles (multifidus and erector spinae) at different walking velocities and slope with surface electromyography.
This study was a prospective experimental study involving ten healthy male participants. Surface electrodes were placed over the multifidus and erector spinae muscles at the L5 and L3 level. After the electrode was placed at the lumbar paraspinalis muscles, electromyography signals were recorded over 20 seconds. Data were collected three times during the walking exercise at a 0° gradient with the speed from 3 to 6 km/hr. At 7° gradient and 15° gradient, data were also collected three times but a walking speed of 4 km/hr. The area under the curve was calculated for quantitative measurement of muscle activation.
While the muscle activation was increased at higher walking velocities at the L5 and L3 levels of the multifidus, the erector spinae muscle activation did not show any change at higher walking velocities. At L3 level of the multifidus and erector spine muscles, the muscle activation was significantly increased in 15° gradient compared to those seen in at 0° gradient. At L5 level, the multifidus and erector spinae muscle activation in 0° gradient was not significantly different from that those seen in 7° or 15° gradient.
Fast walking exercise activates lumbar multifidus muscles more than the slow walking exercise. Also, the mid lumbar muscles are comparatively more activated than low lumbar muscles when the walking slope increases.
Citations
To evaluate whether an initial complete impairment of spinal cord injury (SCI) contributes to the functional outcome prediction, we analyzed the relationship between the degree of complete impairment according to the American Spinal Injury Association impairment scale (AIS), the posterior tibial nerve somatosensory evoked potential (PTSEP) and the changes of functional indices.
Sixty subjects with SCI were studied who received rehabilitative management for over 2 months. The degree of completeness on basis of the initial AIS and PTSEP were evaluated at the beginning of rehabilitation. Following treatment, several functional indices, such as walking index for spinal cord injury version II (WISCI II), spinal cord independence measure version III (SCIM III), Berg Balance Scale (BBS), and Modified Barthel Index (MBI), were evaluated until the index score reached a plateau value.
The recovery efficiency of WISCI and BBS revealed a statistically significant difference between complete and incomplete impairments of initial AIS and PTSEP. The SCIM and MBI based analysis did not reveal any significant differences in terms of the degree of AIS and PTSEP completeness.
AIS and PTSEP were highly effective to evaluate the prognosis in post-acute phase SCI patients. BBS and WISCI might be better parameters than other functional indices for activities of daily living to predict the recovery of the walking ability in post-acute SCI.
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To assess the plantar pressure distribution during the robotic-assisted walking, guided through normal symmetrical hip and knee physiological kinematic trajectories, with unassisted walking in post-stroke hemiplegic patients.
Fifteen hemiplegic stroke patients, who were able to walk a minimum of ten meters independently but with asymmetric gait patterns, were enrolled in this study. All the patients performed both the robotic-assisted walking (Lokomat) and the unassisted walking on the treadmill with the same body support in random order. The contact area, contact pressure, trajectory length of center of pressure (COP), temporal data on both limbs and asymmetric index of both limbs were obtained during both walking conditions, using the F-Scan in-shoe pressure measurement system.
The contact area of midfoot and total foot on the affected side were significantly increased in robotic-assisted walking as compared to unassisted walking (p<0.01). The contact pressure of midfoot and total foot on affected limbs were also significantly increased in robotic-assisted walking (p<0.05). The anteroposterior and mediolateral trajectory length of COP were not significantly different between the two walking conditions, but their trajectory variability of COP was significantly improved (p<0.05). The asymmetric index of area, stance time, and swing time during robotic-assisted walking were statistically improved as compared with unassisted walking (p<0.05).
The robotic-assisted walking may be helpful in improving the gait stability and symmetry, but not the physiologic ankle rocker function.
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To evaluate the effects of power walking (PW) training on a treadmill in patients with coronary heart disease (CHD) and to compare the cardiovascular effects of PW with usual walking (UW).
Patients were recruited as participants in phase 2 cardiac rehabilitation program after receiving percutaneous coronary intervention (PCI) due to acute coronary syndrome from our hospital. The participants were divided into the PW group (n=16) and UW group (n=18). All participants received graded exercise test (GXT) and significant difference in maximal oxygen consumption (VO2Max) was not observed between the groups. Aerobic exercise training on treadmill was given for 50 minutes per session, three times a week, for six weeks. Physiological and hematological parameters were tested before and 6 weeks after the cardiac rehabilitation program. Exercise duration, VO2Max, heart rate, blood pressure, and rate pressure product were evaluated through graded exercise test. Hematological measurements included serum lipid profile, and high-sensitivity C reactive protein (hs-CRP).
There were no significant differences in resting heart rate, maximal heart rate, resting systolic and diastolic blood pressures, lipid profile, hs-CRP, VO2Max, and RPP between the PW group and UW group. However, after 6 weeks of the intervention, VO2Max in the PW group (36.03±5.69 ml/kg/min) was significantly higher than that in the UW group (29.73±5.63 ml/kg/min) (p<0.05).
After six weeks of phase 2 cardiac rehabilitation program, the PW group showed significant improvement in VO2Max than the UW group. Thus, it will beneficial to recommend power walking in cardiac rehabilitation program.
Citations
To provide the off-loading knee brace was designed relief for the pain associated with osteoarthritis by reduce loads on the degenerative compartment of the knee. This study examined the effects of the off-loading knee brace on activation of femoral muscles during squatting, slow and fast walking exercise in healthy young individuals.
Ten healthy male subjects without a history of knee pain were recruited. Each subject was asked to do squatting, slow and fast walking exercises with a brace secured to the dominant leg. The same exercises were repeated without the brace. Surface electromyographic (sEMG) data was collected from the vastus medialis oblique (VMO), vastus lateralis (VL) and biceps femoris (BF) muscles from the dominant side of the leg. All dynamic root mean squre (RMS) values of sEMG were standardized to static RMS values of the maximal isometric contraction and expressed as a percentage of maximal activity.
We found that VMO activity was significantly decreased with application of the off-loading knee brace during squatting and fast walking exercise. However there were no significant differences in VMO activity with application of the off-loading knee brace during slow walking exercise.
These results suggest that the external moment of the brace which effectively stabilized the patella in the movement in which the knee joints become relatively unstable. The brace could be useful in the short term, but for long-term use, weakening of the VMO is predicted. Therefore the program of selective muscular strength strengthening for the VMO should be emphasized.
Citations
Method: The sagittal kinematic and temporospatial data of ramp and level walking were obtained by a motion analyzer for ten healthy young adults.
Results: Compared with the values of level walking, the range of motion of ankle at all degrees for up-hill walking and the ROM of hip at 20o down-hill and all degrees for up-hill walking were significantly different (p＜0.05). The peak dorsiflexion of ankle at 20o of up-hill and at 20o down-hill walking increased significantly (p＜0.05) and peak plantar flexion of ankle at all degrees of up-hill walking increased significantly (p＜0.05). The peak flexion of knee at 20o of up-hill walking increased significantly (p＜0.05) and peak extension of knee at 20o of up-hill and down-hill walking also increased significantly (p＜0.05). The peak flexion angles of hip at all degrees for up and down-hill walking were significantly different (p＜0.05) and peak extension angles of hip at 10o of up-hill walking increased significantly (p＜0.05). The temporospatial data showed no significant difference.
Conclusion: Ramp walking showed a different kinematic gait pattern. So, this study may be useful to evaluate the effect of gait training on the ramp and pathologic gait patterns. (J Korean Acad Rehab Med 2003; 27: 952-957)
Method: 16 hemiplegic patients who could walk without assistive devices were included in this study. We used insole foot-pressure system to measure weight bearing ratio of both feet during walking. We assessed walking speed and pressure ratio during straight or circular walking at their comfortable gait speed.
Results: Pressure ratio of affected foot showed negative correlation with walking time irrespective of walking direction. Pressure ratio of affected foot and walking time during circular walking to the affected side was significantly higher and slower respectively than that to the intact side.
Conclusion: Asymmetrical weight bearing of both feet during walking is highly correlated with walking ability in hemiplegic patients and pressure ratio of affected foot may be simple and useful determinant of walking ability. (J Korean Acad Rehab Med 2003; 27: 173-177)
Objective: The purpose of this study was to examine the changes of cardiopulmonary response and serum lipid level after backward walking training in healthy male college students.
Method: Subjects were ten healthy male college students. Maximal heart rate and VO2max were determined for each subject by administering a Bruce treadmill exercise test after backward walking training during eight weeks. Wilcoxon signed rank test was used to evaluate the changes of the backward walk training.
Results: The study showed that maximal heart rates were 163.7 beat/min in pre-training and 175.8 beats/min in post- training; in contrast, resting heart rates were 72 beat/min in pre-training and 67 beat/min in post-training. The maximal oxygen consumptions were 2111 ml/min in pre-training and 2521 ml/min in post-training. There were significant differences (p＜0.05) in maximal heart rate, heart rate ratio of maximal heart rate (% HR), oxygen consumption, and oxygen consumption ratio of maximal oxygen consumption (% VO2max) between the pre and post-training. The HDL cholesterol level was 42.8 mg/dl in pre-training and 58.0 mg/dl in post-training. There was significant increased of HDL cholesterol in post-training.
Conclusion: We concluded that 5 km/hr backward walk training for eight weeks was an effective exercise program to increase in aerobic capacity of the male college students. (J Korean Acad Rehab Med 2002; 26: 342-346)
Objective: The purpose of this study was to investigate the changes of oxygen consumption and heart rate at forward and backward treadmill walking in healthy male college students.
Method: Subjects were composed of twenty healthy male college students. The oxygen consumption, oxygen consumption ratio of maximal oxygen consumption (VO2max%) and heart rate, heart rate ratio of maximal heart rate (HRmax%) were measured for each subjects by administering a treadmill exercise test at 5 km/hr speed of forward and backward walking. Paired t-test was used to evaluate the difference of the forward and backward walking.
Results: The study showed that heart rate and HRmax% were 120.9 beat/min, 61.6% in forward walking, and 166.1 beats/min, 84.3% in backward walking, respectively. The oxygen consumption and VO2max% were 15.9 ml/kg/min, 37.3% in forward walking, and 23.6 ml/kg/min, 55.8% in backward walking, respectively.
Conclusion: We concluded that 5 km/hr backward walking was more effective exercise program than forward walking to promote health in the college students.
Congenital Achilles tendon contracture is an autosomal dominant disease which is relatively rare. The disease manifests itself as 'toe walking'. Since the clinical condition is relatively benign, it is easy to be overlooked by the clinicians. To the patients, it presents problems of ambulation and activities of daily living. We present a case of 23 year old man who has been walking on his toes. The patient had a difficulty in squatting and tieing shoes and performed poorly gym activities. The patient's father and brother also walked on toes, which made the patient become indifferent to his condition. Upon physical examination, plantarflexion contractures of both ankle joints were 10 degree and the knee were 5 degree. We could not find any abnormal findings in motor or sensory function tests of both lower limbs. Deep tendon reflexes on patella and ankle were within normal range. There were no abnormalities in ankle X-ray, electromyography, blood sample test including muscle enzymes. Gait analysis showed increased ankle plantarflexion moment during entire gait cycle, increased knee flexion during terminal stance, and decreased both knee flexion during initial swing.
Objective: To compare the change of oxygen consumption and heart rate between walking and running at the same condition of treadmill in healthy male college students.
Method: Twenty healthy male college students completed steady-state treadmill test at 3 mph and 5 mph, separately, by walking and running. During the each 6 minutes treadmill test, oxygen consumption (VO2), heart rate (H.R), oxygen consumption ratio of maximal oxygen consumption (% VO2max), and heart rate ratio of maximal heart rate (% HR) were measured each minute.
Results: The showed that mean heart rate were 123.40⁑4.62 beats/min and oxygen consumption were 12.84⁑1.94 ml/kg/min, in 3 mph walking. The mean heart rate were 139.90⁑6.80 beats/min and oxygen consumption were 16.51⁑1.78 ml/kg/min in 5 mph walking. The running showed that mean heart rate were 187.55⁑6.74 beats/min and oxygen consumption were 26.45⁑3.11 ml/kg/min in 3 mph walking. The mean heart rate were 168.45⁑13.34 beats/min and oxygen consumption were 21.05⁑2.00 ml/kg/min in 5 mph walking. There were significant differences (p＜0.05) in mean heart rate, VO2 between the 3 mph walking and running, the 5 mph walking and running.
Conclusion: We concluded that 3 mph walking and running and 5 mph running were an effective exercise to promote health in healthy college students.
Muscle functions are limited in patients with osteoarthritis of knees. In patients with osteoarthritis, isokinetic testing of knee musculature reveals decreased peak torque and increased walking time(50-ft). The purpose of this study was to demonstrate deficiency in muscular performance of knee, and the relationship between walking time and isokinetic parameters of muscular strength, endurance and pain of knee in patients with osteoarthritis of knees. The subjects were divided into a control group and the study group. The control group consisted of 40 persons without a knee pain, and the study group consisted of 30 patients with osteoarthritis of knees. The peak torque of patients in the study group was decreased by 16∼21%, compared to that the control group. There was a negative relationship between the walking time and the endurance of knee extensors(r=0.7195). These findings suggest that exercises to increase the strength and endurance of extensors and flexors of knees should be emphasized in the rehabilitation program for the osteoarthritis of knees.
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